How does nephrosclerosis develop in people with high blood pressure?

Nephrosclerosis is the hardening of the walls of the small arteries and arterioles within the kidney, caused by hypertension (high blood pressure). The development of this condition is classified into two forms based on the rate of progression.1

Benign Nephrosclerosis

This form involves a gradual, prolonged deterioration of the renal arteries. The process begins with the thickening of the inner layer of the walls of smaller vessels, which eventually spreads to the entire wall and may obstruct the central channel. Over time, fat deposits accumulate in the degenerated tissue, and larger arteries develop an excess of elastic tissue, further blocking blood flow. This restricted supply to vital kidney areas leads to progressive tissue deterioration.1

Malignant Nephrosclerosis

In this accelerated form, the disease progresses rapidly. The walls of the arterioles thicken and may close off due to rapid cell growth. As the nuclei of these cells die and elastic fibers disappear, the vessel walls become fragile and prone to rupture, leading to frequent hemorrhages. Arteriolar spasms can force blood through lesions in the vessel walls, causing tissue swelling. Without prompt treatment to lower blood pressure, this can lead to rapid destruction of renal substance.12